Sunday, 12 January 2014

Pelvic floor imaging part 1: do I need a proctogram?

This is the first post of an 8 part series about imaging of the pelvic floor. Pelvic floor imaging is one of my main areas of clinical interest and expertise. Problems with the pelvic floor are not as widely discussed in the media as cancer or heart disease, but my experience of seeing hundreds of patients a year has shown me that it can be incredibly distressing and disabling. Whilst a proportion of women will suffer from pelvic floor problems due to previous trauma at childbirth, in most cases the cause is unknown. Men can also be affected.

In this post, I will discuss what the pelvic floor is, what problems you may suffer from if your pelvic floor fails, and how I can help with your treatment.

The pelvic floor is made up of muscles and connective tissue, and provides support to the organs in the pelvis. The pelvis is divided into three compartments: anterior (front) containing the bladder, middle containing the vagina and uterus in women, and posterior (back) containing the anal canal and rectum. This is shown in the following image: 

(image courtesy of

When the pelvic floor weakens, the support for these organs also weakens and they can start to lose their shape. Because the muscles do not maintain tone, people often have to strain hard to be able to go to the toilet.

Other symptoms that may indicate pelvic floor failure include:

  • straining a lot but not being to open bowels easily (obstructed defaecation)
  • a feeling of needing to go again soon after going to the toilet
  • a feeling of a bulge at the front (rectocoele: rectocele for N American readers)
  • needing to press or push with fingers to help you to go
  • a lump coming out of the back passage when you go to the toilet (prolapse)

The only way of knowing from the outside what is happening is to do some form of scan, known as a proctogram. Technically, this is a defaecating proctogram (defecating for N American readers) because the test is a dynamic test, and done with you straining to see what happens to the pelvic floor when you try to go to the toilet. The test can be done with either xrays (fluoroscopic) or with MRI.

In the next post, I will show you what a proctogram is and how it is done. 

Dr Vikas Shah
Consultant Radiologist

(If you think you need this test, it is advisable to see your doctor first and then I am happy to be involved in any consultations. Please see the Contact Me page for more details).

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